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sirnr�e /�oi: sn <br />KZTTZTAf 9 COUNTY <br />DEPARTMENT OF PUBLIC WORKS <br />FRANCHISE APPLICATION <br />Facility in County Road Right of WAY <br />Fee (,Non -Refundable): $1,615.00 <br />OwnerNamo_f-�Z.v. i <br />Mailing Address <br />Phone Number <br />Applicant Name____L1 <br />Mailing Address r 'I'> ft ",c Vi' <br />Phone Number <br />Payment Method: ❑ Check />`? ❑ Cash <br />Permit #%�i.,,i,((� <br />Pursuant to KCC 15A.03.040, upon receipt of the application, Kittitas County Public Works will <br />contact the applicant to schedule a meeting with the Director of Public Works and/or the County <br />Engineer to discuss terms and conditions of franchise agreement and schedule a Public Hearing for <br />consideration of the franchise agreement by the Board of County Commissioners. <br />Supporting Documents Required for complete application <br />• Detailed Project Plans <br />• Detailed Vicinity Map <br />• Schedule for Work to be performed <br />Applicant is responsible for calling for underground utility locates 48 hours prior to construction. <br />Warning: The County does not mark any of the County infrastructures: the Applicant is responsible for any damage <br />to the County infrastructure. <br />( All required supporting documents have been attached. <br />f Applicant agrees to obtain a work in Right-of-Wav permit upon approval of the franchise agreement. <br />i <br />Applicant/Agent Signature Date <br />v i i M. rcuoy W. rune 1 TEL (509) 962-7523 <br />Ellensburg, WA 98926 FAX (509) 962-7663 <br />